Provider Demographics
NPI:1295818193
Name:THORSEN, JANET LYNNE (SLP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNNE
Last Name:THORSEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 TOURNAMENT RD
Mailing Address - Street 2:
Mailing Address - City:ROTONDA WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33947-2194
Mailing Address - Country:US
Mailing Address - Phone:651-303-1984
Mailing Address - Fax:
Practice Address - Street 1:144 TOURNAMENT RD
Practice Address - Street 2:
Practice Address - City:ROTONDA WEST
Practice Address - State:FL
Practice Address - Zip Code:33947-2194
Practice Address - Country:US
Practice Address - Phone:651-303-1984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19291235Z00000X
MN6096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist